Quality Improvement for Portal Vein Embolization

Excerpt

Major hepatectomy carries a significant risk of mortality. In patients with normal liver bearing metastases, mortality after major hepatectomy ranges from 0.5% to 4%, but in patients [1] with chronic liver disease, such as cholestatic or cirrhotic liver, mortality increases to 4% to 12% [2, 3]. The main cause of mortality as well as postoperative morbidity after major hepatic resection is liver insufficiency, often due to an insufficient liver remnant volume [4, 5]. It has been demonstrated from animal experiments and clinical data that redirection of the portal flow toward a part of the liver will induce hypertrophy of this part. This redirection of portal flow can be obtained by surgical ligation or by percutaneous embolization (PVE). Today, PVE is preferred to surgical ligation to avoid additional surgery. However, when surgery is performed, usually for resection of the primary tumor, and portal vein flow redistribution is required, no clear recommendations can be given regarding whether it is preferable to carry out percutaneous PVE in a second step or ligation at the time of surgery. Some studies have reported greater hypertrophy after PVE [6], whereas others have reported no differences in hypertrophy [7]. The aim of PVE is to (1) preoperatively increase the volume of the future liver remnant to enable surgery and (2) to decrease postoperative morbidity when the only contraindication to surgery is an initially insufficient remnant liver. …